Pain, Postoperative
Conditions
Keywords
pain management, Nephrolithotomy, QLB, ESPB, Erector Spinae, Quadratus Lumborum, Anesthesia, ultrasound, regional anethesia
Brief summary
comparing the subcostal oblique Quadratus Lumborum block and the Erector Spinae plane block in patients undergoing percutaneous nephrolithotomy operation to get the best and longest postoperative analgesic effect.
Detailed description
Here the investigators are going to compare between the Anterior approach for the subcostal oblique Quadratus Lumborum block (QLB) and the Erector Spinae Plane Block (ESPB) to determine their level of spread and their value in controlling postoperative pain in patients scheduled for Percutaneous Nephrolithotomy surgery. We hypothesized that quadratus lumborum is not inferior regarding the duration of analgesia when compared to erector spinae in patients undergoing percutaneous nephrolithotomy under general anesthesia.
Interventions
PROCEDURESubcostal Oblique Quadratus Lumborum Block and Erector Spinae Plain Block.
patients undergo general anesthesia,will be put in prone position.In case of Quadratus Lumborum block 1-3 mL of normal saline is injected to produce hydro-dissection and spread cranially between the QL and kidney. The corresponding ultrasonographic sign is a lunar-shaped hypo-echoic fluid collection observed between the long axis of the kidney and QL muscle. 20 ml Bupivacaine 0.5%, 10 ml Lidocaine 2%, and 10 ml normal saline is administered. In case of the ESPB The location of the needle tip is confirmed by hydro-dissection and after visualizing the fluid spread lifting the Erector Spinae off the transverse process, 20 ml bupivacaine 0.5%, 10 ml Lidocaine 2%, and 10 ml normal saline is injected.
Sponsors
Assiut University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
Yes
Inclusion criteria
* Both sex * Age: 18-60 * ASA (American Society of Anesthesiologists) class I and II * Elective surgery * Patients undergoing PNL surgery
Exclusion criteria
* Patient's refusal * Allergy or contraindications to drugs used in the study * Emergency surgery * Psychiatric disorders * Severely co-morbid patients * Inflammation or infection over injection site * Bleeding diathesis; INR more than 1.5 and Platelet count less than 100,000/mm3 * Peripheral neuropathy * Obese patients BMI ≥35 * Patients on previous opioid therapy * Pre-operative haemoglobin \<10 mg/dl * Inability to properly describe postoperative pain to investigators * Coagulation abnormalities * History of drug addiction or alcohol abuse * History of Previous renal surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Analgesia | 48 hours | Total opioid consumption during the first 48hours postoperatively. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| episodes of nausea and vomiting | within 24 hours postoperative | to investigate if there is or not. |
| Pain Scores using Visual Analog Scale (VAS) Scores | 24 hours postoperative. | VAS is a scale to determine the patient's pain level. |
| ambulation time | 5 days postoperative | time from the end of the surgery to the first time to out-of-bed activity |
| Analgesia | 24 hours | first Analgesic request postoperatively. |
| patient satisfaction with anesthesia | 48 hours postoperative. | Patient satisfaction with anesthesia was assessed using a 5-point scale (5: very satisfied; 4: satisfied; 3: neither satisfied nor dissatisfied; 2: dissatisfied; 1: very dissatisfied) |
| postoperative length of hospital stay | within 2 weeks postoperative. | till time of discharge |
| time of recovery of bowl movement | 5 days postoperative | time from the end of the surgery to the first time of bowl movement |
Countries
Egypt
Outcome results
None listed